Session Title: Vasculitis
Session Type: Abstract Submissions (ACR)
The morbidity and mortality of hospitalized giant cell arteritis (GCA) patients has been largely unexplored. The aim of this study was to analyze inpatient complications experienced by patients with GCA.
We used the Nationwide Inpatient Sample (NIS) database to study a large group of patients admitted with medical and surgical problems that commonly affect the elderly (pneumonia, myocardial infarction, ischemic stroke and femoral neck fracture). Patients were divided in 2 cohorts based on whether or not they carried the diagnosis of GCA. Outcomes evaluated included inpatient mortality, the occurrence of adrenal insufficiency (AI), deep vein thrombosis (DVT), pulmonary embolism (PE), and delirium. GCA and non-GCA groups were compared using chi-square tests. Multivariate logistic regression analysis was performed to control for potential confounders such as age, sex, characteristics of the admitting hospital (teaching versus non-teaching; urban versus rural), and the presence of co-morbid conditions such as diabetes, hypertension, chronic kidney disease, coronary artery disease, and congestive heart failure. In order to maintain the family-wise error rate below a significance level of 0.05, adjustment for multiple comparisons was applied using Bonferroni’s method.
From 2008 to 2011, 8,203,447 patients older than 50 years of age were discharged from acute care facilities across the US after admission with pneumonia (3,232,939), myocardial infarction (2,180,990), ischemic stroke (1,623,564), or hip fracture (1,165,954). Among these individuals, a group of 9,311 (0.11%) carried the diagnosis of GCA. Compared to the non-GCA cohort, GCA patients were significantly older (mean age 80 versus 74 years, p < 0.001) and predominantly female (76% versus 53%, p < 0.001). Most hospitalizations in both GCA and non-GCA subjects occurred in urban locations (~80%).
During hospitalization, 4.1% of the patients with GCA died in comparison to 4.8% of the individuals without GCA (p = 0.006). After accounting for potential confounding factors, multivariable logistic regression analysis showed that the OR for in-hospital mortality among GCA subjects was 0.73 (95% CI 0.66 – 0.81; p < 0.001). In contrast, when compared with the non-GCA population, those with GCA suffered from DVT (1.5% versus 0.7%), PE (0.9% versus 0.6%), delirium (3.1% versus 1.5%), and AI (1.3% versus 0.3%) significantly more often (p < 0.001). Multivariate analyses revealed that GCA persisted as an independent risk factor for each of these complications. The OR for DVT was 2.08 (95% CI 1.76 – 2.45, p < 0.001); for PE, 1.58 (95% CI 1.27 – 1.96, p < 0.001); for delirium, 1.60 (95% CI 1.42 – 1.80, p < 0.001); and for AI, 4.95 (95% CI 4.13 – 5.93, p < 0.001).
GCA patients admitted for pneumonia, myocardial infarction, ischemic stroke and femoral neck fracture had a slight but significant reduction in inpatient mortality compared to the general population. However, GCA was an independent risk factor for AI, DVT, PE and delirium in the hospitalized population. Increased awareness among providers caring for inpatients with GCA may help prevent, diagnose and treat these important complications.
J. H. Stone,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/inpatient-complications-in-patients-with-giant-cell-arteritis-increased-risk-of-thromboembolism-delirium-and-adrenal-insufficiency/